Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Cardiac glycosidesDigoxin62.5mcg tablets: £2.03
125mcg tablets: £2.10
250mcg tablets: £2.04
Digoxin is included in the formulary for use:
Atrial fibrillation: but not paroxysmal AF
Heart failure: where symptoms persist (due to LVSD) despite optimum therapy including ACEIs, B-Blockers and diuretics.
U&Es should be checked at least 6-monthly, or when drug treatment is changed. Monitoring serum potassium is particularly important in patients’ taking digoxin or an aldosterone antagonist. A serum digoxin level should be measured within 8-12 hours of the latest dose only if toxicity or non-adherence is suspected.
Doses of greater than 250mcg per day in adults and greater than 125mcg in patients over 70years should rarely be seen.
Update from NICE: Rate control
1.Offer either a standard beta-blocker (that is, a beta-blocker other than sotalol) or a rate-limiting calcium-channel blocker as initial monotherapy to people with atrial fibrillation who need drug treatment as part of a rate control strategy.
2.Base the choice of drug on the person's symptoms, heart rate, comorbidities and preferences when considering drug treatment. [new 2014]
3.Consider digoxin monotherapy for people with non-paroxysmal atrial fibrillation only if they are sedentary (do no or very little physical exercise). [new 2014]
4.If monotherapy does not control symptoms, and if continuing symptoms are thought to be due to poor ventricular rate control, consider combination therapy with any 2 of the following:
-a beta-blocker
-diltiazem
-digoxin. [new 2014]
5.Do not offer amiodarone for long-term rate control. [new 2014]